Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401415-1 | NY |
NPI | 1033365234 |
---|---|
Provider Name | Mr. Jean Philippe Luc |
First Address | Uniondale, NY 11553 |
Second Address | Uniondale, NY 11553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2008 |
Last Update Date | 30/01/2012 |